Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

Research output: Contribution to journalArticle


Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.


  • Johanna Helmersson-Karlqvist
  • Miklos Lipcsey
  • Johan Ärnlöv
  • Max Bell
  • Bo Ravn
  • Alain Dardashti
  • Anders Larsson
External organisations
  • Uppsala University
  • Karolinska Institutet
  • Dalarna University
  • Karolinska University Hospital
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Anesthesiology and Intensive Care
  • Urology and Nephrology
Original languageEnglish
Article number5882
JournalScientific Reports
Issue number1
Publication statusPublished - 2021
Publication categoryResearch
Externally publishedYes